In December 2021, 69-year-old Bob Warns, of Waukesha, developed a nagging sore throat. The pain was mild and came and went, so he did not think much about it until he had a routine dental checkup in March 2022.
After examining Bob’s swollen tonsils, his dentist referred him to the Froedtert & the Medical College of Wisconsin Cancer Network, where Joseph Zenga, MD, otolaryngologist and MCW faculty member, performed a biopsy. The diagnosis: human papillomavirus-related squamous cell cancer of the tonsils. One tumor, about the size of half of a lime, was on the left side of Bob’s throat near his larynx. Another tumor, about 1 inch by 1 inch, had invaded a lymph node.
HPV-Related Head and Neck Cancer
Head and neck cancers are among the 10 most common cancers in the United States. A decrease in smoking has reduced some types of head and neck cancer, but cases related to human papillomavirus (HPV) are on the rise.
“HPV is highly prevalent in the United States — about 80% of Americans have been exposed to the virus,” said Stuart Wong, MD, medical oncologist and MCW faculty member. “Under certain circumstances, we’re still trying to understand, the virus can get into the deep tissues of the tongue or the tonsils where it can hide from the immune system. Over time, it can lead to cancer.”
Fortunately, HPV-related head and neck cancers have a better prognosis than tobacco-related cancers. But even with a high cure rate, MCW researchers are committed to discovering new ways to reduce treatment side effects and maximize patients’ quality of life. The Froedtert & MCW Cancer Network offers the largest cancer clinical trials treatment program in Wisconsin.
“Our dedicated team of experts perform research in many areas of head and neck cancer,” Dr. Wong said. “And our involvement in national spheres allows us to bring this research and expertise back to patients in Wisconsin. This includes national clinical trials, as well as early-phase and institution-unique trials. Our physicians have specific training in head and neck cancers that can provide the best outcomes for our patients.”
Clinical Trial Participation
At first, Bob was unsure he wanted to participate in clinical trials, but he felt reassured after learning they have well-established protocols. There was also a chance trials could improve his treatment and reduce side effects.
“I decided that if I can help someone else down the line by participating, I would do it,” he said.
Bob enrolled in a national clinical trial that reduced his treatment time and intensity. Instead of the typical 35 radiation therapy treatments in seven weeks, he received 30 radiation treatments in five weeks, along with immunotherapy. By decreasing treatment toxicity to critical areas of the head and neck, researchers hoped to reduce long-term side effects such as dry mouth, swallowing difficulty, voice changes and hearing loss.
“Head and neck cancer care is complex,” said Musaddiq Awan, MD, radiation oncologist and MCW faculty member. “It requires finding the balance between disease control and retaining functions like swallowing, eating, tasting and talking that are fundamental to human existence.”
Bob also enrolled in two clinical trials unique to the Cancer Network. The first study used a buprenorphine patch on the skin with oral tramadol to relieve radiation-induced pain — an alternative to potentially addictive opioids. The other clinical trial tested a device for muscle strength training to improve swallowing after radiation therapy.
Supportive Services Ease Secondary Issues
Access to clinical trials is just one of the resources available to Froedtert & MCW head and neck cancer patients. The Cancer Network also offers extensive wraparound care, including speech pathology, audiology, dietitian services, emotional support and more.
“We’re not only interested in providing leading-edge cancer therapies, but also the vital supportive care that helps improve patients’ quality of life,” Dr. Wong said.
Bob, who has always been healthy and active, tolerated radiation therapy and immunotherapy well. The hardest part was losing his appetite during treatment. He dropped 40 pounds.
He finished treatment in August 2022, and by fall, was feeling like his old self. He went back to his job at a hardware store, resumed playing his beloved weekly basketball games and celebrated the end of treatment with a road trip to Glacier National Park with his wife, Bridget.
Bob’s care team continues to monitor him, and he has no long-term side effects other than the occasional neck cramp. He is grateful for the vast expertise he found within the Cancer Network and still gets emotional when recalling his team’s compassion.
“I always felt like I was the only person they were caring for,” he said. “It felt like I was visiting friends.”